Active NPI
Robin Colleen Wand, PSYD
- Psychologist
- Oakland, CA
National Provider Identifier
1366651028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 17603
- Practice address
- 2579 San Pablo Ave
Oakland, CA 94612-1159 - Phone
- (510) 446-7103
- Fax
- (510) 832-0609
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 17603 | CA | Primary |
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | PSY 17603 | CA |
Addresses
Primary practice location
2579 San Pablo Ave
Oakland, CA 94612-1159
Mailing address
2579 San Pablo Ave
Oakland, CA 94612-1159
Phone (510) 292-9885
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY 17603 | Other | CA | PSYCHOLOGY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 17603 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432771200000",
"number": "1366651028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2579 SAN PABLO AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946121159",
"telephone_number": "510-292-9885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2579 SAN PABLO AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946121159",
"telephone_number": "510-446-7103",
"fax_number": "510-832-0609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAND",
"first_name": "ROBIN",
"middle_name": "COLLEEN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2015-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 17603",
"primary": true
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "PSY 17603",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "PSY 17603",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.